Returning Resident's Visa Application (INZ 1004) - Immigration New ...

OFFICE USE ONLY Client no.: Date received: / / Application no.:
About endorsement applications
For further information on immigration
visit www.immigration.govt.nz
INZ 1174
New Zealand Citizen
Endorsement Application
An endorsement is evidence of New Zealand citizenship for people travelling to New Zealand on a foreign
passport and is current for the duration of the passport in which it is endorsed.
You cannot include your family members in this application. Your partner and children will need to complete
separate application forms and pay separate application fees.
Holders of returning resident’s visas issued under the Immigration Act 1987
If you were issued a returning resident’s visa (RRV) under the Immigration Act 1987 on the grounds that you are a
New Zealand citizen, you may travel to and enter New Zealand as a New Zealand citizen until the expiry of the passport in
which the RRV is endorsed.
How much does an endorsement cost?
For information about fees:
• see our Fees Guide (INZ 1028)
• see our website www.immigration.govt.nz/fees
• contact your nearest Immigration New Zealand (INZ) office.
Where do you send your application and documents?
If you are outside New Zealand send your completed application form and documents to your nearest INZ office,
New Zealand Embassy, or New Zealand High Commission. If you are in New Zealand send your completed application form
and documents to your nearest INZ office.
For full details see www.immigration.govt.nz/contactus.
Evidence
See Section C: Application details for the evidence required. You must include your foreign passport for endorsement.
Immigration Advisers Licensing Act 2007
Under the Immigration Advisers Licensing Act 2007 it is an offence to provide immigration advice without being licensed
or exempt. If your immigration adviser is not licensed when they should be, Immigration New Zealand will return your
application. For more information and to view the register of licensed advisers, go to the Immigration Advisers Authority
website www.iaa.govt.nz or email info@iaa.govt.nz.
When filling in this form, print clearly in English using CAPITAL LETTERS.
Application type
This form may be used to apply for a first endorsement, or a second or subsequent endorsement.
Tick one of the following options to indicate what you are applying for:
I am applying for a first endorsement.
I have previously been granted an endorsement and am applying for a second or subsequent endorsement.
November 2010

When filling in this form, please print clearly using CAPITAL LETTERS.
Section A Applicant’s personal details
A1 Are you including a New Zealand passport issued on or after 5 November 2005 with
this application?
Yes
No You must attach a passport-sized photograph of yourself here. The photograph must be less than
six months old. Write your full name on the back of the photograph.
A2 Name as shown in foreign passport
Family/last name
Given/first name(s)
A3 Gender Male Female A4 Date of birth
A5 Town/city of birth
Country of birth
A6 Country of citizenship
A7 Foreign passport details
Number
Country
Section B Contact details
B1 Name and address for communication about this application
Name
Company name (if applicable) and address
Telephone (daytime)
Fax Email
2 – New Zealand Citizen Endorsement Application
Telephone (evening)
Expiry date
B2 If you have given someone else’s name above do you authorise that person to act on your behalf?
Yes No Not applicable
B3 Have you received immigration advice on this application?
Yes Make sure that your immigration adviser completes Section E: Immigration Adviser’s Details.
No
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3.5cm

Section C Application details
If you are applying for a first endorsement complete C2 . If you have previously been granted an endorsement and you
are applying for a second or subsequent endorsement complete C3 .
C1 Tick the one option that applies to you.
I want an electronic endorsement only (no label).
I want an endorsement label in my foreign passport.
C2 Applying for a first endorsement Tick below to show the evidence you are providing of your New Zealand citizenship.
You must provide an original or a certified copy of one of the following.
New Zealand passport
New Zealand birth certificate issued prior to 1 January 2006
New Zealand birth certificate issued on or after 1 January 2006 that positively indicates citizenship
Certificate of grant of New Zealand citizenship
Confirmation of New Zealand citizenship by descent certificate issued under section 7(2) of the Citizenship Act 1977
An evidentiary certificate issued under section 21 of the Citizenship Act 1977 confirming that you are a
New Zealand citizen.
C3 Applying for a second or subsequent endorsement Tick below to confirm.
I confirm that I previously held a foreign passport with an endorsement confirming New Zealand citizenship.
Section D Declaration by applicant
I have provided true and correct answers to the questions in this form.
I confirm that I am currently a New Zealand citizen and I know of no reason why I should not be issued an endorsement.
I authorise Immigration New Zealand to make any enquiries it deems necessary regarding the information provided on
this form and to share this information with other government agencies (including overseas agencies) to the extent
necessary to make decisions about my immigration status. I also consent to any organisation providing relevant
information to Immigration New Zealand about me.
I understand that if I have received immigration advice from an immigration adviser and if that immigration adviser
is not licensed under the Immigration Advisers Licensing Act 2007 when they should be, Immigration New Zealand will
refuse to accept my application.
Signature of applicant Date D D M M Y Y Y Y
Signature of parent or guardian (if applicant under 18 years)
Date D D M M Y Y Y Y
New Zealand Citizen Endorsement Application – 3

When filling in this form, please print clearly using CAPITAL LETTERS.
Section E Immigration adviser’s details
This section must be completed by the applicant’s immigration adviser. If the applicant does not have an immigration
adviser, this section does not have to be completed.
E1 Tick the one option that applies to you
I am a licensed immigration adviser under the New Zealand Immigration Advisers Licensing Act 2007. Go to E2
I am exempt from licensing under the New Zealand Immigration Advisers Licensing Act 2007. Go to E3
E2 Licensed advisers. Provide your licence details.
Licence type
full provisional
4 – New Zealand Citizen Endorsement Application
limited. List conditions specified in the register.
Licence number 2 0 Go to Section F: Declaration by person assisting applicant .
E3 Exempt from licensing. Tick one box below to show why you are exempt from licensing.
I provided immigration advice in an informal or family context only, and I did not provide the advice
systematically or for a fee.
I am a New Zealand member of Parliament or member of their staff and I provided immigration advice as part
of my employment agreement.
I am a foreign diplomat or consular staff.
I am an employee of the New Zealand public service and I provided immigration advice within the scope of my
employment agreement.
I am a lawyer and I hold a current practising certificate as a barrister or as a barrister and solicitor of the High
Court of New Zealand.
I am employed by, or I am working as a volunteer for, a New Zealand community law centre where at least one
lawyer is on the employing body of the community law centre or is employed by or working as a volunteer for the
community law centre in a supervisory capacity.
I am employed by, or I am working as a volunteer for, a New Zealand citizens advice bureau.
Go to Section F: Declaration by person assisting the applicant.

Section F Declaration by person assisting applicant
This section must be completed and signed by the applicant’s immigration adviser, or by any person who has assisted
the applicant by providing immigration advice, explaining, translating, or filling in the form for the applicant. If the
applicant does not have an immigration adviser, and no one helped the applicant to fill in this form, this section does
not have to be completed.
If you are unlicensed when you should be licensed under the Immigration Advisers Licensing Act 2007, Immigration New Zealand will return your client’s application.
It is an offence to provide immigration advice without holding a licence. For more information, go to the Immigration Advisers Authority website
www.iaa.govt.nz, or email info@iaa.govt.nz or write to them at PO Box 6222, Wellesley Street, Auckland 1141, New Zealand.
Name and address of person assisting applicant. Same as address given at B1 , or as below.
Family/last name Given/first name(s)
Company name (if applicable) and address
Telephone (daytime)
Fax
Email
Telephone (evening)
I understand that after the applicant has signed this form it is an offence for me to change or add further information,
change any documents attached to the form, or attach any further documents to the form. However, if changes are
needed, the person making the changes must state on the form what information or documents have been changed and
give reasons for the changes.
I note that the maximum penalty for this offence is a fine of up to NZ$100,000 and/or a term of imprisonment of up to
seven years.
I certify that the applicant asked me to help them complete this form and any additional forms. I certify that the
applicant agreed that the information provided was correct before signing the declaration.
I have assisted the applicant as an interpreter/translator
I have assisted the applicant with filling in the form
I have assisted the applicant in another way. Specify
I have provided immigration advice (as defined in the Immigration Advisers Licensing Act 2007) and my details in
Section E: Immigration adviser’s details are correct.
Signature of person assisting
Date D D M M Y Y Y Y
New Zealand Citizen Endorsement Application – 5

When filling in this form, please print clearly using CAPITAL LETTERS.
6 – New Zealand Citizen Endorsement Application
This form has been approved under section 381 of the Immigration Act 2009.

About the information you provide
Immigration New Zealand collects the
information about you on this form to decide
whether you are eligible for an endorsement. We may
also use the information to contact you for research
purposes or to advise you on immigration matters.
The address of Immigration New Zealand is
PO Box 3705, Wellington, New Zealand. This is not
where your application should be sent.
Collecting the information is authorised by
the Immigration Act 2009 and the Immigration
Regulations made under that Act. You do not have
to provide the information, but if you do not we are
likely to not grant your application.
The information we collect may also be used to
determine whether you are allowed to board
a flight to New Zealand. We will not share your
personal information with airline check-in agents;
however, we will send a boarding message to the
airline check-in agent based on the information you
have provided in this form.
Immigration New Zealand may also share the
information you have provided with other government
agencies that are entitled to it by law, or with other
agencies (as you have agreed in the declaration).
If you are in New Zealand, you will be able to ask to
see the information we hold about you and have any
of it corrected if you think it is necessary.
For more information
If you have questions about completing the form:
• see our website www.immigration.govt.nz
• telephone our call centre on 0508 558 855
(within New Zealand)
• contact one of Immigration New Zealand’s offices.
Immigration New Zealand has offices in Apia,
Bangkok, Beijing, Ho Chi Minh City, Hong Kong,
Jakarta, London, Moscow, Mumbai, New Delhi,
Nuku’alofa, Pretoria, Shanghai, Singapore, Suva,
Sydney and Taipei. You can also contact New Zealand
diplomatic and consular offices.
In New Zealand offices are located in Auckland,
Henderson, Manukau, Hamilton, Palmerston North,
Wellington, Christchurch, Queenstown and Dunedin.
Section G Paying your application fee
See our Fees Guide (INZ 1028) or our website
www.immigration.govt.nz/fees for more information about
current fees and payment methods.
Your application fee
Amount you are paying:
Currency
Application number
(office use only)
Preferred methods of payment
We recommend that you use one of the following methods
of payment for better security and faster processing.
Bank cheque/bank draft
Mastercard*
Visa*
SWITCH card (UK only) SWITCH card issue number
Credit card*/SWITCH card details
Name of cardholder
Card number
Expiry date D D M M Y Y Y Y
Signature of cardholder
Date D D M M Y Y Y Y
Other methods of payment
Personal cheque. Note that we will hold your application for
10 working days to allow the cheque to be cleared.
Cash. Our New Zealand branches do not accept cash. Most of our
branches outside New Zealand do not accept cash.
We do not accept money orders.
To be removed and securely destroyed after credit card transaction is
processed.
*Your CVC/CVV number is required if you are paying by
electronic credit card and your application is being lodged
at Immigration New Zealand’s Bangkok branch or London
branch, or the MFAT post in The Hague. If your application
will be lodged in one of these branches, please provide your
CVC/CVV number here.
Note: your CVC/CVV number is the three-digit number found
on the signature strip on the back of your credit card.
New Zealand Citizen Endorsement Application – 7

When filling in this form, please print clearly using CAPITAL LETTERS.
8 – New Zealand Citizen Endorsement Application